腹腔镜直肠癌全直肠系膜切除术临床分析21例

The clinical analysis of laparoscopic radical resection(total mesorectal excision)of rectal carcinoma

目的探讨直肠癌腹腔镜下全直肠系膜切除(TME)手术的可行性及操作经验。方法回顾分析2011年5月～2012年5月本院21例腹腔镜直肠癌根治术患者的临床资料。结果 21例患者中17例顺利完成腹腔镜手术,4例中转开腹手术,无术后出血、吻合口漏及吻合口狭窄发生。手术平均时间180 min,术中出血量100～180 ml,术后2～4 d胃肠功能恢复,所有标本残端无癌细胞浸润或残留,清扫淋巴结数6～27个,术后平均住院时间7 d,术后随访至2012年6月,局部复发1例。结论腹腔镜直肠TME手术技术上是可行的、安全的,具有手术创伤小、术后恢复快、胃肠道干扰小、术后疼痛轻、瘢痕小等优点。手术后的长期效果有待进一步观察。

Objective To investigate the feasibility and experience of laparoseopic radical resection （TME）for rectal carcinoma. Methods The clinical data of 18 cases of laparoscopic radical recteet for rectal cancer patients from May 2011 to May 2012 were analyzed retrospectively. Results Seventeen cases of 21 patients successfully completed by laparoscopic surgery. 4 cases were converted to open laparotomy with no operative deaths,post operative bleeding,an astomotic leakage,an astomotie stenosis. The average operative time break was 180 min, Blood loss was 100 - 180 ml, gastrointestinal function recovered after operation at 2 - 4 d. All specimens stump were found with non-cancer cell infiltration.The average hospital stay after surgery is 7 days. There was 1 case local reeurrenced in the postoperative follow up until Jun. 2012. Conclusion The laparoscopy assisted TME operation for the treatment of colorectal carcinoma is technically feasible and safe, and it shows some advantages such as minimal invasion, short recovery time, little gastrointestinal influence, slight postoperative hurt and small scar. However, its long- term effects after operation need further researches.